Analysis and Identification of Risk Factors for Intradialytic Hypotension in Patients Undergoing Maintenance Hemodialysis

OBJECTIVE: This paper aimed to identify factors associated with intradialytic hypotension (IDH) in patients receiving maintenance hemodialysis (MHD) and to develop a practical risk prediction model for early clinical assessment. METHODS: A retrospective analysis included 142 patients on MHD, divided into an IDH group (n = 48) and a non-IDH group (n = 94) based on intradialytic systolic blood pressure decline and related clinical intervention. Blood pressure parameters, demographic characteristics, dialysis prescription, biochemical indicators, and bone mineral metabolism markers were collected. Independent risk factors for IDH were identified via multivariate logistic regression of univariate significant variables, and a nomogram was constructed based on regression coefficients. Model performance was assessed using the Hosmer-Lemeshow test, calibration curve, ROC analysis, and bootstrap internal validation. RESULTS: Patients with IDH showed lower intradialytic SBP/DBP and greater blood pressure reduction than those without IDH (p < 0.05). Older age, higher dry weight (DW), transferrin saturation, and parathyroid hormone (PTH) levels were associated with IDH in univariate analysis (p < 0.05). Multivariate analysis confirmed age (OR = 1.059), DW (OR = 1.043), and PTH (OR = 1.001) as independent risk factors (p < 0.05). Based on these three factors, the constructed nomogram model showed good calibration (Hosmer-Lemeshow test p = 0.249), with an AUC of 0.750 (95% CI 0.674-0.837), and an internally validated corrected C-index of 0.740 (95% CI 0.662-0.825). CONCLUSION: Advanced age, increased DW, and elevated PTH are significant predictors of IDH in MHD patients. The nomogram provides a reliable tool for individualized early warning and risk evaluation.